Provider Demographics
NPI:1811050560
Name:PYRON HUGO, AMY GRACE (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:GRACE
Last Name:PYRON HUGO
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:GRACE
Other - Last Name:HUGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:7492 COUNTY ROAD 15 SW
Mailing Address - Street 2:
Mailing Address - City:STEWARTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55976-8195
Mailing Address - Country:US
Mailing Address - Phone:507-951-9942
Mailing Address - Fax:
Practice Address - Street 1:300 1ST AVE NW STE 210
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2830
Practice Address - Country:US
Practice Address - Phone:507-951-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123091041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN647227300Medicaid
MN647227300Medicaid
MN800000955Medicare ID - Type Unspecified